The Many Types of Arthritis Program Recap

Thank you to Dr. Sehris Khawaja, fellowship trained rheumatologist for Capital Health Rheumatology Specialists, for presenting on the different kinds of arthritis, including symptoms, diagnosis, and treatment options. Arthritis affects millions of American each year and is the leading cause of disability. There is no one-size fits all approach to diagnosing or treating the many different kinds of arthritis; however, exercise and movement can help stave off the effects of many types of arthritis. Early detection is important for the treatment and management of all arthritic conditions so be sure to consult your physician about any pain, swelling, or stiffness in your joints.

What is Arthritis?

Arthritis is the broad term for a host of different conditions that cause pain in the joints of the body. Often marked by swelling, stiffness, and decreased range of motion, in addition to pain, arthritis is common, especially as we age. Depending on the type of arthritis, treatments can range from exercises to injections to medications to surgery for severe cases. Its possible to suffer from multiple arthritic conditions simultaneously. If you are experiencing any of the symptoms above, please consult with your physician or a rheumatology specialist.

Osteoarthritis (OA)

Osteoarthritis it the most common form of joint pain in middle-aged and elderly people. Affecting over 300 million people worldwide, it is often described as “wearing and tearing” of joints, but often involves multiple components, including cartilage, joint lining, and bone. In many cases, OA results from a dramatic reduction in cartilage or the joint lining, causing ligaments and bones to rub directly against each other that results in varying levels of pain, swelling, and stiffness. The most common areas to experience OA include the hand joints, knees, spine, hips, shoulder, and great toe.

Symptoms of OA include brief morning swelling, pain, functional limitation, and gelling phenomenon where the synovial fluid in the joint becomes thickened when not in use. Risk factors for OA include older age, family members with OA, obesity, previous traumatic joint injury, repetitive overuse of joints, and joint deformities. Treatment options include exercise, physical therapy (quadriceps strengthening, stationary bike), paraffin wax machine for hand pain, localized steroid injections, topical creams (diclofenac), oral medications (Tylenol, Non-steroidal anti-inflammatory drugs, Duloxetine), and surgery.

Gout

Gout is the most common inflammatory arthritis for adults in the United States. Gout occurs when crystals are deposited in the joint and soft tissues, causing acute, abrupt onset of redness, warmth, swelling, and pain. Episodes of gout usually last for a week or 2 before dissipating. Gout is much more prevalent in men and associated with an increased risk of cardiovascular disease mortality. The most common area infected is the great toe, but may affect other areas, including the elbow, wrist, fingers, knee, ankle, and midfoot. The diagnosis is made based on the clinical history, labs, x-rays, and joint fluid analysis.

The risk factors for gout include a high purine diet (red meat, shellfish), alcohol consumption (especially beer), trauma in the joint, surgery, illness complications (dehydration, starvation), obesity, renal impairments, and genetic mutations. Treatment for gout includes medications (Allopurinol, Colchicine, Prednisone), localized injections, icing joints, and some homeopathic remedies may also help (tart cherry juice, low fat dairy products).

Polymyalgia Rheumatica (PMR)

Unlike osteoarthritis and gout which tend be localized, polymyalgia rheumatica manifests as widespread aching and stiffness, generally equally on both sides of the body. Signs include trouble raising arms, hip/pelvic girdle pain with stiffness, or difficulty moving hands or wrists. Generally, achiness is worse in the morning and improves as the day goes on and may be accompanied by low grade fevers, poor appetite, or fatigue. Workup for PMR may include blood tests to detect inflammation and the use of ultrasound to look for bursitis or synovitis. PMR treatment consists of low doses of prednisone anywhere from a couple of months to 2 years.

Rheumatoid Arthritis

Rheumatoid arthritis is the most common type of autoimmune arthritis where the body starts to attack the small joints of the hands and feet. A majority of people affected by RA are women between the ages of 20 and 60. Symptoms of RA include morning stiffness in joints, fatigue, low grade fever, loss of appetite, dry eyes and mouth, eye inflammation, and shortness of breath from possible lung disease. RA diagnosis includes a thorough medical history, a physical exam looking for signs of tenderness and swelling, labs checking for RF and anti-CCP antibodies, ESR and CRP, and anemia, and finally x-rays, ultrasounds, and MRIs may also be ordered. Treatments for RA includes disease-modifying antirheumatic drugs (Methotrexate, Hydroxychloroquine, Leflunomide, Sulfasalazine) and biologic agents (Humira, Enbrel, Cimzia). Early detection and treatment is especially important when it comes to rheumatoid arthritis.

Psoriatic Arthritis

Psoriatic arthritis is another type of autoimmune arthritis and up to 30% of people with psoriasis will develop PsA. It can affect any joint in the body and common manifestations include sausage fingers, knee swelling, back pain known as spondyloarthritis, and pain in joints where tendons and ligaments attach to bone. Manifestations are very similar to that of rheumatoid arthritis, but also include eye inflammation (Uveitis) and nail issues, such as pitting and separation of the nail from the nail bed. Genetics plays an important role in the development of PsA and it is equally seen in males and females. Many of the same treatments for RA can also be used for PsA.

Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory form of arthritis that specifically affects the spine and sometimes involves peripheral joints. It mostly affects males between in their 20s and 30s and is influenced by the gene HLA B27. Symptoms include low back stiffness that gets better with activity, alternating buttock pain, and awakening at night with back pain. If left untreated, it can result in “bamboo” spine where the vertebrae start to fuse together around the joint. Treatment for Ankylosing spondylitis includes NSAIDs, TNF inhibitors (Enbrel, Humira, Remicade), and medication that targets interleukins, specifically IL-17 (Cosentyx and Taltz).

Lyme Disease

Lyme disease is an infection that results from a bacterial organism which enters the body when certain infected ticks bite humans. There are three stages of infection:

Early localized stage – This is when a rash in the form of a bullseye develops
Early disseminated stage – This stage is marked by worsening rash, fever, joint and muscle pain, headaches, and issues regarding the heart
Late stage – Lyme arthritis starts to develop, most commonly as a swollen knee, and there may be issues involving the nervous system, including numbness, tingling, and weakness

Course of treatment for Lyme disease is antibiotics, but effects can linger after the disease is treated.

More Information

As with all medical information, please consult your physician for all diagnosis and treatment options. For more information about arthritis, including types, treatment, and other resources, please visit the Arthritis Foundation at www.arthritis.org. If you have any questions, please reach out to Dr. Sehris Khawaja at skhawaja@capitalhealth.org. You can view a recording of the webinar at https://youtu.be/xiYZWtuTB2A.